Special Open Enrollment for the Health Insurance Exchange
All states are now participating in the special open enrollment period for the Health Insurance Exchange, although the dates may vary. If a state is not listed then it is federally facilitated and the special enrollment period is February 15th – May 15. It was recently announced that states participating with healthcare.gov will extend to August 15th. More to come if the state-based exchanges will also follow suit.
American Rescue Plan
Aside from the $1,400 per person stimulus checks, there are additional aspects of the American Rescue Plan that could have a large impact on Medicaid and government programs.
March 2021 Medicaid State of the Union
With the news of presidents Biden's executive order to open up a special enrollment period with healthcare.gov the State of California has also decided to extend open enrollment for Covered California.
The state is following suit with the federal government and opening up a special enrollment period for the health exchanges from February 8 – May 15th. Colorado Dept. of Health Care Policy and Financing published “PM 21001, Remote Application Assistance” providing guidance to those assisting clients remotely.
On January 15, 2021 CMS once again approved the MMA 1115 waiver that limits retro-active Medicaid from the traditional 90 days to the month of application. As in the past, this does not include pregnant woman and children.
In October, CMS approved the 1115 waiver titled Georgia Pathways. The 1115 waiver partially expands coverage to childless adults along with qualifying activity requirements such as employment, education, or volunteering. This waiver is set to go live July 1, 2021.
On February 12, 2021 CMS sent a letter to the state advising of the intent to withdraw work requirements, but no official changes have been made yet. If they remove work requirements and continue with the rest of the waiver more people will be covered, but there may not be retro coverage for the newly expanded group.
The state is a state facilitated health exchange but has also opened up a short special enrollment period from March 1st – March 31st 2021.
CMS conditionally approved Indiana’s request to require some adult Medicaid beneficiaries to work or participate in other “community engagement” activities to remain eligible for coverage, contingent on the Supreme Court legally authorizing the provisions.
The state decided to part ways with the 3rd party contractor, Maximus who assisted the state with processing Medicaid applications among other duties. Beginning in 2021, the duties will not be handled in-house as the state has hired the New Jersey based company Conduent.
Medicaid expansion was once again introduced as an addition to a bill that adds more funding to mental health clinics. The amendment was quickly rejected leaving Medicaid expansion in Kansas an unlikely possibility.
Effective January 1, 2021, all Presumptive Eligibility Medicaid members will be enrolled in Managed Care and assigned to United Healthcare Community Plan of Kentucky (UHC). Governor Andy Beshear notified CMS that Kentucky plans to transition back to the Kynect system, with a fully state-run exchange by the fall of 2021.
Bills 55 and 56 were approved by the Senate Health and Welfare committee to remove co-payments and cost-sharing for Medicaid recipients and to limit the number of Managed Care Medicaid contracts to three.
The state’s legislative sessions will convene April 12, 2021. Some of the healthcare related bills surround the pandemic, telemedicine and the cost of Medicaid.
Medicaid expansion was on the agenda during legislative sessions but both proposals to expand the program to childless adults were rejected. In addition, the state is considering longer postpartum Medicaid coverage for new mothers and their babies allowing women enrolled in Medicaid to keep their coverage up to 1 year after giving birth, an increase from the current limit of 60 days.
Medicaid enrollment numbers have jumped nearly 100,000 people since COVID-19. July 2021 Medicaid expansion will begin and its predicted Medicaid enrollment will increase to about 275,000 people.
Nevada is a state facilitated health exchange and does not utilize the federal healthcare.gov platform but they have decided to follow suite and also open up the special enrollment time frame from February 15 – May 15, 2021.
Legislators approved a Medicaid package that increases next year’s funding by over $460M and directs the program begin its long-delayed shift from traditional payments to managed care by July 2021. Internal works sessions began in January for the changes with the director of government payers to make sure we understand the details and the impact of the change on Medicaid eligibility operations.
The state announced plans to transition about 21,000 of its Insure Oklahoma members to the Medicaid Expansion program, effective July 1, 2021. Internal work sessions began in January to make sure we are ready for the new influx of recipients. Health Care Authority announced the selection of Blue Cross Blue Shield of Oklahoma, Oklahoma Complete Health, Humana Health Horizons and UnitedHealth care as the four for-profit companies it will use to outsource the care of most of the state’s Medicaid population.
The South Carolina Department of Health and Human Services (SCDHHS) is adding an additional managed care organization (MCO) to serve Healthy Connections Medicaid members. Humana will be contracting with SCDHHS beginning July 1, 2021. Providers should expect to receive correspondence from Humana as they begin contracting with providers and continue to develop their provider network.
CMS approved Tennessee’s 1115 Waiver to fund Medicaid through a block grant on January 8, 2021 titled TennCare III. The state will continue covering the mandatory populations as stated by federal law but does not need federal approval for additional groups added. There will be no changes to prescription drug coverage in 2021 but there may be in the future. There is a spending cap and per the state it is below current spending and if the state reaches the cap in the future the state would pay for services with 100% state funds.
State Representative Lyle Larson filed legislation to bring the question of Medicaid expansion directly to voters. Approval is unlikely but, legislation seeks a state constitutional amendment requiring a 2/3 majority in both the Texas House and Senate before voters could decide on it.
Legislation and budget season wrapped up for the state. The budget includes $5 million to increase caseworker salaries at the Utah Division of Child and Family Services. Originally there was a plan to merge the department of health and the department of human services but that idea was rescinded.
Since January 2019, over 500,000 people have gained coverage due to Medicaid expansion. The state is allowing verbal consent on traditional Medicaid applications.